title: Rectosigmoid endometriosis: comparison between CT water enema and video laparoscopy.
abstract: OBJECTIVE
  To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard.
  
  
  METHODS
  Thirty-three women (mean age 33.4 ± 3.1 years) suspected of having deep pelvic endometriosis underwent 64-row CT and video laparoscopy within 4 weeks. Two radiologists blinded to the clinical data evaluated the CT images obtained after colonic retrograde distension using water as the contrast medium, and a comparison with laparoscopic and histological findings was performed. CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The radiation dose to patients was estimated. Cohen's weighted kappa (κ) test was used to evaluate the interobserver agreement.
  
  
  RESULTS
  In 23 out of 33 patients (69%) intestinal implants were found at surgery and pathological examinations. CT confirmed the diagnosis of rectosigmoid endometriosis in 20 out of 23 implants. Three nodules located on the proximal sigmoid colon (two serosal lesions and one infiltrating the muscularis layer) with a diameter of less than 1 cm were not diagnosed. CT sensitivity, specificity, PPV, NPV, and accuracy values were 87, 100, 100, 77, and 91%, respectively. The mean effective dose estimate was 6.30 ± 1.7 mSv. Almost perfect agreement between the two readers was found (k = 0.84).
  
  
  CONCLUSIONS
  Water enema CT can play a role in the diagnosis of bowel endometriosis and represents another accurate potential tool for video laparoscopic approaches, especially in patients for whom MRI is contraindicated.
authors.affiliation: Interdisciplinary Department of Medicine, Section of Radiology, University of Bari Medical School, Italy. a.stabile@radiologia.uniba.it
authors.forename: A A
authors.initials: AA
authors.lastname: Stabile Ianora
authors.forename: M
authors.initials: M
authors.lastname: Moschetta
authors.forename: F
authors.initials: F
authors.lastname: Lorusso
authors.forename: S
authors.initials: S
authors.lastname: Lattarulo
authors.forename: M
authors.initials: M
authors.lastname: Telegrafo
authors.forename: L
authors.initials: L
authors.lastname: Rella
authors.forename: A
authors.initials: A
authors.lastname: Scardapane
mesh_terms: D000328:Adult; D000075202:Contraindications; D004715:Endometriosis / Q000175:diagnosis*; D004733:Enema / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008279:Magnetic Resonance Imaging; D015588:Observer Variation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012810:Sigmoid Diseases / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods; D020535:Video-Assisted Surgery / Q000379:methods; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water